DataBank Indicator

Well-Child Visits

“Well-child” pediatric visits to promote good health and development are recommended for all children. In 2013, 68 percent of children younger than six who were not covered by health insurance had received a well-child check-up in the past year, compared with 92 percent of children who were covered by health insurance.

Importance

During a well-child visit, a pediatrician provides preventive care by assessing a child’s physical, behavioral, developmental, and emotional status. A well-child visit is a critical opportunity to detect a possible developmental delay or disability, early treatment of which can lessen the future impact on both the child and family.[1]

In addition, well-child visits allow physicians to promote behaviors conducive to healthy development, and to give age-appropriate counseling, or anticipatory guidance.[2],[3] Research shows that parents want more information in basic areas of childrearing, such as discipline or how to encourage learning; one study found that more than half (53 percent) of parents surveyed reported that they could use more guidance in at least three of six areas.[4],[5] Anticipatory guidance given during a well-child visit can change parenting practices (for example, by encouraging the use of time-outs instead of harsher forms of discipline[6]), and increase knowledge of injury prevention practices and infant sleep patterns.[7]Physician guidance has also been found to increase the likelihood that parents will read to their child, and that a child will be breastfed.[8]

The American Academy of Pediatrics’ age-specific recommendations for preventive pediatric care cover the following areas: medical history, measurement (such as height, weight, blood pressure), sensory screening (vision and hearing), developmental/behavioral assessment, physical examination, immunizations, anticipatory guidance (in such areas as injury prevention and nutrition counseling), and dental referral.[9],[10] As infectious childhood diseases become less prevalent, guidelines have become increasingly focused on encouraging pediatricians to address the parent/child relationship and other psychosocial aspects of development.[11],[12]

Trends

The proportion of children under age six who received a well-child check-up in the past year was 91 percent in 2013, an increase from 84 percent in 2000. Most of the increase has been since 2006, when the proportion reached a low of 83 percent. (Figure 1)

Differences by Health Insurance Coverage

In 2013, children without health insurance coverage were significantly less likely than children with coverage to have received a well-child check-up in the past year (68 versus 92 percent, respectively). (Figure 2) However, this gap has been shrinking since 2007, when only 57 percent of uninsured children received a well-child check-up. (Appendix 1) Of those who had health insurance, children covered by public health insurance were less likely to have received a well-child visit than those with private insurance (89 and 94 percent, respectively). (Figure 2)

Hispanic children are less likely than white and black children to receive a well-child check up. In 2013, 86 percent of Hispanic children received a well-child check up, compared with 92 percent of white and black children, each. (Appendix 1)

Differences by Parental Education

Children with parents who have more education are more likely to receive a well-child check-up. In 2013, children whose parents had a bachelor’s degree or more were most likely to have received a well-child check-up in the past year (96 percent), followed by those whose parents had some college and children whose parents had only a high school diploma (91 and 86 percent, respectively), and children of parents with less than a high school degree (79 percent). (Figure 3)

Differences by Immigrant Status

Children under age six with at least one foreign-born resident parent were less likely than children with no foreign-born parent to have received a well-child check-up in the past year (86 compared with 92 percent, respectively, in 2013). (Figure 1)

Differences by Age

Although in the past younger children were more likely than older children to have received a well-child check-up, in 2013 they were equally likely to have received one. (Figure 4)

State and Local Estimates

The Data Resource Center for Child & Adolescent Health provides state-level “NSCH medical home profiles”. A medical home is a source of care where the child has a personal doctor or nurse, and receives family-centered care that is comprehensive, coordinated, and culturally sensitive.

International Estimates

None available.

National Goals

The American Academy of Pediatrics (AAP) recommends that children visit their pediatrician for a well-child check-up as a newborn; at 3 to 5 days post-partum; by one month; at two, four, six, nine, twelve, fifteen, eighteen, twenty-four, and 30 months; and once a year between the ages of three and 21 years. The AAP has published “Guidelines for Health Supervision III,” which includes recommendations for each well-child visit from birth to 21.

What Works to Make Progress on This Indicator

A Well-Visit Planner, based on recommendations from the American Academy of Pediatrics, offers guidance to parents and guardians on what to expect from a well-child visit, how to prepare for it ahead of time, and how to ensure their top-priority questions are addressed. More information is available here.

Related Indicators

Definition

In the context of this indicator, a child received a well-child check-up in the past year if his or parent answered “yes” to the question, “During the past twelve months, did {sample child} receive a well-child checkup- that is a general checkup when {he/she} was not sick or injured?”

Data Source

Data for 2000-2013: Original analyses by Child Trends of the National Health Interview Survey.

1Persons of Hispanic origin may be of any race.2Parental education reflects the education level of the most educated parent in the child’s household.3At least one family member receives benefit.Source: original analysis by Child Trends of National Health Interview Survey data 2000-2013.